Bill Text: OH HB185 | 2009-2010 | 128th General Assembly | Engrossed

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Bill Title: To specify that a material amendment to a health care contract does not become part of the contract unless agreed upon by both parties.

Spectrum: Slight Partisan Bill (Democrat 35-12)

Status: (Engrossed - Dead) 2009-10-22 - To Insurance, Commerce, & Labor [HB185 Detail]

Download: Ohio-2009-HB185-Engrossed.html

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As Passed by the House

128th General Assembly Regular Session 2009-2010

H. B. No. 185

Representatives DeGeeter, Book 

Cosponsors: Representatives Garland, Murray, Lundy, Huffman, Domenick, Chandler, Letson, Slesnick, Yuko, Okey, Oelslager, Snitchler, Foley, Goyal, Combs, Gardner, Moran, Blair, Fende, Heard, Amstutz, Lehner, Stebelton, Batchelder, Koziura, Bolon, Boyd, Carney, Celeste, DeBose, Dyer, Evans, Garrison, Grossman, Harris, Harwood, Luckie, Mallory, Patten, Pillich, Pryor, Weddington, Williams, B., Winburn, Yates 

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A BILL

To amend section 3963.04 of the Revised Code to

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specify that a material amendment to a health care

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contract does not become part of the contract

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unless agreed upon by both parties.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That section 3963.04 of the Revised Code be	5
amended to read as follows:	6

Sec. 3963.04. (A)(1) If an amendment to a health care	7
contract is not a material amendment, the contracting entity	8
shall provide the participating provider notice of the amendment	9
at least fifteen days prior to the effective date of the	10
amendment. The contracting entity shall provide all other	11
notices to the participating provider pursuant to the health	12
care contract.	13

(2) A material amendment to a health care contract shall	14
occur only if the contracting entity provides to the	15
participating provider the material amendment in writing and	16
notice of the material amendment not later than ninety days prior	17
to the effective date of the material amendment. The notice shall	18
be conspicuously entitled "Notice of Material Amendment to	19
Contract."	20

(3) If within fifteen days after receiving the material	21
amendment and notice described in division (A)(2) of this	22
section, the participating provider objects in writing to the	23
material amendment, and there is no resolution of the	24
objection, either party may terminate the health care contract	25
upon written notice of termination provided to the other party	26
not later than sixty days prior to the effective date of the	27
material amendment.	28

(4) If the participating provider does not object to the	29
material amendment in the manner described in division (A)(3) of	30
this section, the material amendment shall be effective as	31
specified in the notice described in division (A)(2) of this	32
section.	33

(5) If the participating provider objects to the material	34
amendment in the manner described in division (A)(3) of this	35
section, and there is no resolution, and neither party terminates	36
the health care contract, the material amendment shall not become	37
part of the existing health care contract.	38

(B)(1) Division (A) of this section does not apply if the	39
delay caused by compliance with that division could result in	40
imminent harm to an enrollee, if the material amendment of a	41
health care contract is required by state or federal law, rule,	42
or regulation, or if the provider affirmatively accepts the	43
material amendment in writing and agrees to an earlier effective	44
date than otherwise required by division (A)(2) of this section.	45

(2) This section does not apply under any of the following	46
circumstances:	47

(a) The participating provider's payment or compensation is	48
based on the current medicaid or medicare physician fee schedule,	49
and the change in payment or compensation results solely from a	50
change in that physician fee schedule.	51

(b) A routine change or update of the health care contract is	52
made in response to any addition, deletion, or revision of any	53
service code, procedure code, or reporting code, or a pricing	54
change is made by any third party source.	55

For purposes of division (B)(2)(b) of this section:

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(i) "Service code, procedure code, or reporting code" means	57
the current procedural terminology (CPT), current dental	58
terminology (CDT), the healthcare common procedure coding system	59
(HCPCS), the international classification of diseases (ICD), or	60
the drug topics redbook average wholesale price (AWP).	61

(ii) "Third party source" means the American medical	62
association, American dental association, the centers for medicare	63
and medicaid services, the national center for health statistics,	64
the department of health and human services office of the	65
inspector general, the Ohio department of insurance, or the Ohio	66
department of job and family services.	67

(C) Notwithstanding divisions (A) and (B) of this section, a	68
health care contract may be amended by operation of law as	69
required by any applicable state or federal law, rule, or	70
regulation. Nothing in this section shall be construed to require	71
the renegotiation of a health care contract that is in existence	72
before the effective date of this sectionJune 25, 2008, until the	73
time that the contract is renewed or materially amended.	74

Section 2. That existing section 3963.04 of the Revised Code	75
is hereby repealed.	76